As an L&D nurse I have chosen not to participate in terminations. I am in no way being judgemental to those who do.....this is just my personal and professional decision. I have never had a problame with my employer.....in fact they have supported me completely. for example....19 weeker came in ruptured (with heart tones)....MD talked with pt extensively....pt agreed to pitocin. I talked with my charge nurse. No one on the unit that night wanted to take this patient. A nurse was called at home and came in to help. I took care of the patient until this nurse arrived. Of course treated her with the upmost dignity, respect, and compassion. Did not start pit...and gave report to the oncoming nurse. Everyone was very supportive of me....especially my charge nurse.
Fast forward....
A termination was already delivered when I came to work....I was assigned to her. I politly and privatly asked to be reassigned. I was told NO. This patient was already delivered and I had no religious bases for declining the patient. Again....I treated this patient with repect and compassion. However, the patient (who was very understandably emotional) was asking me things like "I did the right thing, right?" "Do people in my situation do the same thing" I am sure she has been asking herself these things to herself since the diagnosis. I didn't know what to say....this was why I didn't want to take this patient.....I didn't like being in this position!!! So I responed with statements like...."I know this was a very difficult decision for you" "is there anything I can do for you to make you more comfortable" I (hope) I never did or said anything to make this patient feel I was being judgemental.....
My questions is...what can I do or say in the future to keep this from happening again....this was a very uncomfortable situation for me.
I once told a patient I was going to be an indian giver and take her water away because the doctor had just given me an NPO order (new transfer never seen the patient and her name was very caucation sounding something like april smith) wouldn't you know it she was native american. Not good, insert foot into mouth (chomp chomp)
There is no fine line IMO. If there is no live baby, then you have no right to refuse that assignment. If you don't ever want anything to do with a termination, even the post termination care, then you should consider finding a workplace that doesn't do them at all. I think your employer did what was right in getting another nurse to start pit on a termination. They honoured your moral beliefs as they should have. I also think they were right in expecting you to accept post termination care. That's about you honouring your commitment to them.
You go into the room and you say exactly what you probably did say (I don't know what I would do, I'm sorry you have to go through this, I know this is such a difficult decision and all you can do is what you think is best in a bad situation, no one has any right to judge you, etc)... Don't avoid it because it makes you uncomfortable. Believe it or not, even those of us who agree with their decision and participate in terminations are often uncomfortable with the whole thing. The difference is we do it anyways. You can too and you can make a big difference in the experience that poor woman has.
I personally couldn't assist in a termination, but if the fetal death is confirmed by US, that changes the whole ballgame for me. Baby is already dead, I am just assisting in delivering him/her. I don't do L/D so we only deliver under 20 weeks on the floor, which is technically considered a miscarriage anyway. But if I did, I would have no moral problem assisting with delivery of an IUFD. That is completely different to my way of seeing things.
I personally couldn't assist in a termination, but if the fetal death is confirmed by US, that changes the whole ballgame for me. Baby is already dead, I am just assisting in delivering him/her. I don't do L/D so we only deliver under 20 weeks on the floor, which is technically considered a miscarriage anyway. But if I did, I would have no moral problem assisting with delivery of an IUFD. That is completely different to my way of seeing things.
I think a lot of people feel this way. The thing is, nurses don't have the right to refuse post termination care. It doesn't matter why the termination was done. They may have to go in and provide care to a woman who they feel should not have chosen termination. It isn't an easy place to be, but there is no real reason why one nurse shouldn't have to do it and another should.
Post termination care is fine with me too. It's been done, it's over. I have no problem with caring for someone post-termination. We had a lady on our floor not too long ago post-elective AB that went into DIC, spent some time in the unit, had to have an embolization and very nearly died. Poor thing, she was in her early 20s. My point is that I would have had no problem caring for her had she been assigned to me. I too am anti-AB but would not have a problem caring for someone who's already had one done. That's just me.
I think you have right to refuse to participate in the actual termination process, but I think once the patient has delivered you should take care of them. I am okay w/ personally participating in a termination that involves a lethal anomaly, but not for an unwanted pregnancy or something like Down's. I will tell you honestly that I have been lucky enough to have never been in this type of situation as a patient. I am human, so I won't sit in judgement of what I would do if I were the patient. I think none of us know until we are actually facing a bad situation on the receiving end. I feel that my beliefs prohibit me from participating in most of these situations, so I work where I would not be expected to participate in the termination of a live viable fetus/baby. I took care of a patient who had her pregnancy reduced at another hospial because one twin was Down's. Sadly, she was losing the other. I had no problem w/ this. Others I worked w/ did not want to take care of her. I couldn't go back and change what she did. Since my assignment did not involve me doing something to assist in the termination process, I had no issue w/ caring for her. She was a very nice woman. If a patient was having a termination and was hemorrhaging, arresting, etc I would certainly step in and be right there for her. Though it is a much "milder" example, I would not participate in something like a breast augmentation for a 15 year old. It is just against my beliefs that this is something I would want to take any responsibility in. I wish I could think of a better example. I did work in a place that did elective terminations for a short time. It gave me the creeps #1 and I did feel it was somewhat unfair for other people to get stuck all the time w/ this type of patient. It wasn't a good work environment. It was definitely a divisive issue. Good luck. I think you did a good job in your approach to this patient.
That's a very difficult situation. Many people believe whatever the doctor says is the Gospel truth. If the doctor thought pitocin was the best choice in that situation then she may have simply gone along with what the doctor was saying. As nurses, we know doctors are fallable.
I would not have been able to administer the pitocin. I would not have refused to take the patient after the fact. "I'm sorry" would be all I felt was appropriate to say.
I have taken care of post elective termination patients. The reason they were in the hospital was due to complications such as infection. I didn't like taking care of them but didn't feel I should refuse because it was their decision to terminate and they will have to be the ones to live with the consequences.
Whether or not they picked up on my feelings I don't know. I try to be compassionate with every patient.
Specializes in Acute Hemodialysis, Cardiac, ICU, OR.
But I don't believe that conscientious objection should extend to the post-termination period. The emotional care of a patient who has experienced a pregnancy loss (elective or not) is difficult for everyone, and if those with religious objections are allowed to opt out of this aspect of care, the burden will fall disproportionately to the nurses who don't state such objections. Even nurses who support abortion rights will have difficulty handling questions like, "Did I do the right thing?" Also, to my knowledge, there is nothing involved in the care of a post-termination patient that violates any religious tenets. If a patient initiates a discussion or asks questions that you don't feel capable of answering, you can always consult social services or offer a clergy referral.
I understand your discomfort, but don't believe that it is a sufficient reason to decline an assignment.
I agree -- part of working in L&D means working in these types of situations -- just like there are uncomfortable situations, or cases we'd rather not be involved with, in EVERY specialty area. Not to sound cold, but if you are unable or unwilling to accept these infrequent assignments, you may need to find another unit -- if L&D is your passion, perhaps working in a birthing center (where elective terminations would never occur) would be a better location.
I would have probably commended her on how brave she was and let her know I supported her in the tough decision she had to make and that I knew she was acting in good faith and doing the best she knew to.
I would be traumatized if I had to work in a situation like this. I want to commend you for your bravery, too, BTW.
It sounds as though you did a good job of giving the patient proper care despite your feelings, but perhaps you need to reexamine whether there is some underlying judgementalism when you want to refuse to care for the patient even when it would not require you to participate in the actual procedure to which you have moral objections. It sounds as though you are saying (my interpretation only of course) that your discomfort trumps her need for care. We all have to care every day for patients whose actions and behaviours we may find truly objectionable.
By the way, I hope you extend your appreciation to those nurses who come in extra to cover so that others can be relieved of the assignment. I've done so on my days off, both for the sake of my coworkers and of the patient who needs someone who is not displaying on any level disapproval of her. People can tell by behaviours (such as avoiding the room and giving minimal care) when someone disapproves of what they are doing.
In the end, you have to go with what you can ethically deal with, as long as patients are not endangered, being willing to accept the consequences of this even if it means you have to work in a different setting than L&D.
I think a lot of people feel this way. The thing is, nurses don't have the right to refuse post termination care. It doesn't matter why the termination was done. They may have to go in and provide care to a woman who they feel should not have chosen termination. It isn't an easy place to be, but there is no real reason why one nurse shouldn't have to do it and another should.
I start my RN program this Fall, and when I read the OP's request to not engage in post-termination care, that was my first thought as well.
However, for the OP to participate in post-termination care, and for the patient, that obviously needed support in her decision...that would be a tough, tough spot to be in.
SuesquatchRN, BSN, RN
10,263 Posts
*snort*